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新生儿脐膨出的呼吸管理_joanne Baerg_Loma Linda大学Childrenâ ' ' s医院，美国
摘要
脐膨出是一种先天性脐环缺陷并伴有内脏突出。尽管在新生儿护理方面取得了进展，但对于活产婴儿，死亡率仍保持在5%至25%之间。出生时呼吸衰竭是脐膨出婴儿死亡率的独立预测因素，但其原因是多种多样的。在本报告中，巨型和非巨型脐膨出进行比较，因为巨型脐膨出有更多的呼吸困难。产前预测的产后呼吸衰竭和护理策略进行了讨论。肺发育不全的定义。从历史上看，胎儿和婴儿有脐膨出的报告显着降低胸部容量。最近，胎儿磁共振成像(MRI)扩大了对脐膨出婴儿先天性肺容量减少的认识。临床-放射学相关研究支持使用产前MRI来预测产后观察到的呼吸功能不全的程度。主要异常对呼吸困难的贡献进行了讨论。 Infants with omphalocele may have increased pulmonary vascular reactivity and pulmonary hypertension which increases the risk of postnatal mortality. In this presentation, pulmonary hypoplasia and pulmonary hypertension are defined as separate entities. The two diagnoses must be distinguished from each other in the clinical setting. The implications of congenital heart defects are explained. The role and objectives of assisted ventilation in respiratory failure are expanded. Since 2011, infants with omphalocele and respiratory failure have required the extracorporeal membrane oxygenator. The first review of the Extra-Corporeal Life Support (ELSO, Ann Arbor, MI USA) database for causes of respiratory failure and outcomes in omphalocele infants will be presented. The timing of surgical repair, postoperative complications such as compartment syndrome, delayed surgical closure techniques, and the implications of a ruptured omphalocele are explained. Abnormalities in lung function, chronic lung disease, the role of tracheostomy, influence of gastroesophageal reflux disease (GERD), prematurity, and improved outcome strategies are discussed. The giant omphalocele represents an important subset of omphalocele infants. Giant omphalocele is defined as an omphalocele defect containing more than 75% liver in the sac and / or a diameter greater than 5 cm. A non-giant omphalocele is generally defined as a defect with a diameter of less than 5 cm. Previous definitions that measured the defect in centimeters do not take into account differences in height and gestational age of infants. The definition that giant omphalocele is a defect containing more than 75% liver in the sac is preferable and consistent. Giant omphalocele is associated with a poor prognosis in many studies. Giant omphalocele is often associated with a higher incidence of respiratory failure, longer ventilation requirements, and an increased incidence of pulmonary hypoplasia and pulmonary hypertension. Infants with giant omphaloceles have significantly higher neonatal morbidity. When large and small omphaloceles are compared, median length of stay (47 vs 10 days), median age at complete enteral feeding (23 vs 5 days), median duration of mechanical ventilation (23 vs 7 days) and supplemental oxygen requirements at 30 days of life (88% vs. 27%) are significantly longer for infants with giant omphaloceles. Respiratory failure is the leading cause of death in infants with giant omphaloceles. In the neonatal period, these infants have significantly more pulmonary hypoplasia and pulmonary hypertension and therefore more breathing difficulties
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